Comparing four methods to inform parents about child behavior

Resident: J. Hencler
Date: 09/18/2009

Article title: Comparing four methods to inform parents about child behavior management: how to inform for consent

Author(s): Allen, PhD; Hodges, DDS; Knudsen, MS
Journal: Pediatric Dentistry 17:3 1995
Major topic: Informed consent delivery methods
Type of Article: Comparative Survey

Main Purpose:
Compare 4 methods for informing parents to gain their consent for eight behavior management techniques: Tell-show-do (TSD), Nitrous oxide (NO), Passive restraint (PR), Voice Control (VC), Hand-over-mouth (HOM), Oral premedication (OP), Active/physical restraint (AR), and General anesthesia (GA). This study was designed to determine how best to inform the parent, which procedures parents feel should require informed consent prior to use, which behavior management techniques parents are willing to consent to, and variables that may influence parental willingness to consent.

Overview of method of research:
Descriptions of procedures were provided to 120 parents by one of 4 methods: 1) Video 1 of technique during live appointment with an accompanying explanation before video is viewed, 2) video 2 of technique without explanation, 3) written presentation, and 4) oral presentation.

Findings:
Written method produced fewer parents who felt informed (61%). The oral method resulted in 97% of the parents feeling well informed while video 1 produced 80% and video 2 produced 89% of parents feeling well informed. The oral method produced the highest consent rates (80%). Parents were willing to consent significantly more to VC, AR, and NO than to PR or HOM. Parents reported that they felt info about each technique was relevant to their decisions to consent and more than 75% of all parents believed informed consent should always be obtained for the most invasion techniques including NO, PR, HOM, OP, and GA. 60% felt strongly that they should be informed about each technique, even TSD.

Key points in the article discussion:
The oral method of delivering info to parents about child behavior management techniques was the best method of ensuring the average parent felt well informed and was likely to consent. Videotapes are time-saving but data suggests may not provide adequate info. Written method may be a poor alternative for gaining consent because it was significantly worse than any other method as a means of informing patients. The fact that both the written and oral methods contained the same info suggests a problem in the transfer of that info (reading or comprehension). Techniques such as HOM and PR were much likely to receive consent from parents. Age, anxiety and socio-economic status were not reliable predictors of consent for behavior management techniques.

Summary of conclusions:
The results of this study suggest an inter-personal (oral) delivery of info to parents about each technique is most likely to result in parents who feel well informed and who are likely to provide written consent. Handing parents a written form to read independently and sign, or having them watch videos showing techniques do not appear to be adequate to ensure that parents are well informed and likely to consent.

Assessment of article:
Good article, results not surprising. I would think that explaining techniques to parents would result in them being more informed resulting in written consent.